July 2015
Swank Health: Your monthly news from Swank HealthCare

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Did You Know?

Patient Falls: still a significant issue

What's Going On?

Learn how the Swank HealthCare Advantage has helped one hospital save over $16,000!

Recommended Readings
Top List
Now Trending

Test your knowledge of patient falls by answering these quick questions.

Customer Spotlight

Recommended Courses*
  • #314814 Slips and Trips: Fall Risk Identification and Prevention
  • #45211 Falls: Prevention
  • #41313 Dizziness and Falling

* course numbers may vary by facility

View Courses

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Expired Courses

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Did You Know?

Patient Falls: still a significant issue

In September, The Joint Commission published Sentinel Event Alert Issue 55: Preventing Falls and Fall-related Injuries in Health Care Facilities. This newest alert focuses on contributing factors to patient falls and includes suggested solutions for prevention. Despite an earlier Sentinel Event Alert on patient falls issued in July 2000, they continue to be a significant patient safety issue. According to The Joint Commission website, the topic was chosen for the latest alert because patient falls with serious injury are among the top 10 reported sentinel events since 2009. Of those reported during that time, 63 percent resulted in death and the remaining sustained injuries. Other studies show that between 2 and 10 percent of inpatients fall during a hospital stay, and of those, 30 to 50 percent result in injury.

Monetary Penalties

As of October 2008, the Centers for Medicare and Medicaid Services (CMS) no longer reimburses hospitals to treat injuries from falls in hospitals if they could have been prevented during a Medicare beneficiary’s stay. Falls in healthcare facilities that result in patient death or serious disability are among the National Quality Form’s list of serious reportable events. Some states use this NQF list of “never events,” or a variation of it, as a basis for non-payment for treatment of injuries in the Medicaid program. In addition to the burden of these costs, in 2008 the Aon Corporation reported that hospital-acquired injuries (primarily falls-related) account for about 1 in 12 closed claims, the average of which was $48,000 in 2007.

Contributing Factors

The latest fall-related Sentinel Event Alert lists the most common contributing factors for falls as:

  • Inadequate assessment
  • Communication failures
  • Lack of adherence to protocols and safety practices
  • Inadequate staff orientation, supervision, staffing levels or skill mix
  • Deficiencies in the physical environment
  • Lack of leadership
  • Staff education and training

Staff education is the foundation for a successful fall prevention program. Almost 80% of organizations reporting fatal falls to the Joint Commission from 1995 to 2005 cited incomplete staff orientation and training as a factor. All clinical and nonclinical staff should participate in mandatory training programs that include the purpose and goals of a falls prevention program. Training should be reinforced with ongoing mandatory clinics, education, and other means such as printed materials. Education for clinical staff should cover:

  • Intrinsic and extrinsic causes of falls
  • Instructions for conducting a complete risk assessment
  • Falls prevention interventions
  • Correct transfer techniques
  • Placement of high-risk patients in rooms near the nurses’ station
  • Use of patient lifts
  • Use of assistive devices and aids
  • Use of commodes and shower chairs
  • Instructions for completing a post-falls assessment
  • Hazard and incident reporting
  • Post-falls education for patients

Other Interventions

In addition to education and training, facilities should implement a number of interventions that address the specific risk factors that individual patients face.

Communicating the patient fall risk. Falls are more likely to occur when staff are not informed of a patient’s risk for falling. This includes failure to communicate during nursing report, shift changes, or transfer from a hospital to another facility, not documenting changes in condition, and inadequate communication about patient condition and history of falling from family members. Ways to increase awareness of high-risk patients include:

  • Standardized, color-coded armbands or wristbands
  • Indicators in the medical record, at call light stations, and on nursing station whiteboards
  • Placing patients near the nursing station once assessed as high-risk
  • Indicators on patient’s beds or doors

Patient and family education. Facilities must provide education for both the patient and family about the causes and interventions to prevent falls. This should include one-on-one verbal discussions, which should be documented in the patient’s chart. Education should include, but is not limited to:

  • How and when to use nurse call system
  • When it is NOT advised to get out of bed without assistance
  • Factors that put patients at high-risk for falls (medications that cause dizziness, surgery that may impede normal movement ability, etc.)
  • How to walk and get out of bed safety (use hand rails, ensure pathways are clear)
  • In case other methods fail, how to fall gently (walking close to a wall and leaning into the wall if they feel themselves falling) and what to do if they fall (wait for assistance rather than attempt to get up without help)
  • Safe use of wheelchairs, canes, and walkers

Patient rounding. A regular schedule for nurses to conduct rounds of patient rooms to check on patient needs has been shown to reduce the number of falls.

Some studies have provided evidence that low staffing levels increase the likelihood of falls. Patients are more likely to get out of bed without assistance, even when instructed not to do so, when nurses are assigned a large number of patients and do not respond in a timely manner to patient call lights.

Medication review. Facilities are advised to utilize pharmacy staff in identifying opportunities to reduce fall risk potential through medication review. This may include opportunities to reduce medication doses, discontinue medications, or substitution of alternate drugs with lower fall risk potential. Some healthcare facilities have developed a list of medications that increase risk for falls, along with strategies to alert caregivers when they are selected. Medications most likely to increase the risk of falls include: benzodiazepines, antipsychotics, diuretics, antidepressants, neuroleptics, opioids, oral hypoglycemic, and anti-hypertensives.

Environmental assessments. Patient rooms should be evaluated and modified to the needs of each patient. Fall hazards should be identified and actions should be taken immediately to remove or reduce them. Patients and family members should be educated about physical hazards that might contribute to a fall and how to avoid them. See environmental assessment in Top 10 List below.

Reduced use of restraints. Restraint use may be hazardous to patients, lead to rapid physiologic and psychological deterioration, and increase the risk of severe injury or death if the patient tries to escape from or remove the restraint. Federal regulations state that patients have “the right to be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff.” When using restraints, staff must use extreme care and strictly adhere to appropriate policies and care procedures for applying restraints and monitoring restrained patients.

Use of technology. Proper selection and use of technology can play an important role in reducing the risk of falls. All equipment should be properly maintained and used according to evidence and policy. Applications of technology for reducing the prevalence of falls include: bed-exit alarms, lowered bedrails, lowered beds, nurse call systems, ambulation and transfer aids, and hip protectors.

What's Going On?

Learn how the Swank HealthCare Advantage has helped one hospital save over $16,000!

Our goal at Swank HealthCare is to provide an education system for healthcare that not only saves money, but also helps increase efficiencies and is flexible to fit the unique needs of your facility. Read how Swank HealthCare was able to help one hospital save over $16,000 in one year.

Want to highlight your hospital? Contact your account manager and we'll work directly with you to identify your return on investment.

Recommended Readings

Top List

All patient care staff should conduct a 360-degree environmental assessment every time they enter or leave a patient’s room.

  1. Ask if the patient needs to use the bathroom, if room temperature is comfortable, or if he/she needs anything that would require getting out of bed. Helping patients meet these needs before leaving the room may prevent the temptation to get out of bed without assistance.
  2. Keep the bed in a low position with wheels locked and side rails down (per policy). When rails are up, falls are more likely if patients try to climb over them to get out of bed.
  3. Make sure the wheels of bedside tables and cabinets are locked to prevent rolling.
  4. Keep equipment (IV poles, oxygen tubing, plugged-in devices) out of the patient’s pathway.
  5. Eliminate hazards, such as inadequate lighting, wet floors, and clutter.
  6. Place call lights, TV remote controls, eyeglasses, hearing aids, tissues, telephones, and other personal items within reach.
  7. Ensure mobility aids, such as walkers and canes are fitted appropriately to the patient.
  8. Instruct patient about and assist with wearing safe, non-slip footwear.
  9. Keep hallways and railings unobstructed.
  10. If indicated and available, make sure auditory alerts such as bed, chair, and personal alarms are turned to the “on” position.

Now Trending

Test your knowledge of patient falls by answering these quick questions.

What is the average cost for treatment of a fall with injury?

A. $4,500
B. $6,000
C. $10,000
D. $14,000

Which of the following is NOT a known risk factor for falls in the hospital setting?

A. Impaired balance or gait
B. History of falls
C. Age > 80 years
D. Recent surgery
E. Recent history of antibiotic use
F. Impaired cognition
G. Visual impairment
H. Hypotension

At which of the following times should a patient be assessed for fall risk?

A. On admission
B. When physical condition changes (new medications, after surgery, return from PT)
C. When a fall or near miss has occurred
D. When transferred to a new unit or level of care
E. As required by state and federal regulations
F. All of the above

Customer Spotlight

The 20 highest ranked critical access hospitals in the country were announced at the recent National Rural Health Association on October 2, 2015. Congratulations to the following Swank HealthCare Customers who were recognized for their great achievement!

Top 20 Overall

Memorial Health Care Systems, NE

Top 20 in Quality

Memorial Health Care Systems, NE
Trinity Hospital Twin City, OH

Top 20 in Patient Satisfaction

Regional West Garden County Hospital, NE

Top 20 in Financial Stability

Memorial Medical Center, WI
Theda Care Medical Center, WI
Johnson County, WY

Share your story, tell us where your hospital will be this month or
what topics you would like to see in upcoming newsletters.

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D - $14,000



E – Recent history of antibiotic use is NOT a known risk factor for falls.



F – All of the above.